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Hellenic Association for the Study of the Liver Clinical Practice Guidelines: Autoimmune hepatitis
Autoimmune hepatitis (AIH) is a relatively rare acute or chronic liver disease of unknown etiology characterized by large heterogeneity. Its distribution is global, covering all ages, both sexes and all ethnic groups. The aim of the present Clinical Practice Guidelines (CPG) of the Hellenic Associat...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hellenic Society of Gastroenterology
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302199/ https://www.ncbi.nlm.nih.gov/pubmed/30598587 http://dx.doi.org/10.20524/aog.2018.0330 |
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author | Dalekos, George N. Koskinas, John Papatheodoridis, George V. |
author_facet | Dalekos, George N. Koskinas, John Papatheodoridis, George V. |
author_sort | Dalekos, George N. |
collection | PubMed |
description | Autoimmune hepatitis (AIH) is a relatively rare acute or chronic liver disease of unknown etiology characterized by large heterogeneity. Its distribution is global, covering all ages, both sexes and all ethnic groups. The aim of the present Clinical Practice Guidelines (CPG) of the Hellenic Association for the Study of the Liver was to provide updated guidance and help to gastroenterologists, hepatologists, internists and general practitioners for AIH diagnosis and management. AIH diagnosis is based on clinicopathological characteristics: namely, polyclonal hypergammaglobulinemia, particularly of immunoglobulin G (IgG), circulating autoantibodies, interface hepatitis on liver histology, absence of viral hepatitis, and a favorable response to immunosuppression. Clinical manifestations at disease onset are variable, ranging from asymptomatic to the acute/severe form. Aminotransferase and bilirubin levels vary, while the presence of hepatitis at the histological level is a prerequisite for diagnosis. Autoantibodies are the hallmark for AIH diagnosis; therefore, the CPG describe the appropriate serological algorithm for their detection. AIH therapy should aim to achieve complete biochemical (normalization of IgG and aminotransferases) and histological remission. All patients who have active disease, even those with cirrhosis, should be treated with individualized and response-guided induction therapy using prednisolone in combination with azathioprine or mycophenolate mofetil as first-line therapy. Immunosuppression should be given for at least 3 years and for at least 2 years after the achievement of complete biochemical response, while a liver biopsy should be recommended before treatment discontinuation. Current CPG are also provided for several specific conditions and difficult-to-treat patients. |
format | Online Article Text |
id | pubmed-6302199 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Hellenic Society of Gastroenterology |
record_format | MEDLINE/PubMed |
spelling | pubmed-63021992019-01-01 Hellenic Association for the Study of the Liver Clinical Practice Guidelines: Autoimmune hepatitis Dalekos, George N. Koskinas, John Papatheodoridis, George V. Ann Gastroenterol Special Article Autoimmune hepatitis (AIH) is a relatively rare acute or chronic liver disease of unknown etiology characterized by large heterogeneity. Its distribution is global, covering all ages, both sexes and all ethnic groups. The aim of the present Clinical Practice Guidelines (CPG) of the Hellenic Association for the Study of the Liver was to provide updated guidance and help to gastroenterologists, hepatologists, internists and general practitioners for AIH diagnosis and management. AIH diagnosis is based on clinicopathological characteristics: namely, polyclonal hypergammaglobulinemia, particularly of immunoglobulin G (IgG), circulating autoantibodies, interface hepatitis on liver histology, absence of viral hepatitis, and a favorable response to immunosuppression. Clinical manifestations at disease onset are variable, ranging from asymptomatic to the acute/severe form. Aminotransferase and bilirubin levels vary, while the presence of hepatitis at the histological level is a prerequisite for diagnosis. Autoantibodies are the hallmark for AIH diagnosis; therefore, the CPG describe the appropriate serological algorithm for their detection. AIH therapy should aim to achieve complete biochemical (normalization of IgG and aminotransferases) and histological remission. All patients who have active disease, even those with cirrhosis, should be treated with individualized and response-guided induction therapy using prednisolone in combination with azathioprine or mycophenolate mofetil as first-line therapy. Immunosuppression should be given for at least 3 years and for at least 2 years after the achievement of complete biochemical response, while a liver biopsy should be recommended before treatment discontinuation. Current CPG are also provided for several specific conditions and difficult-to-treat patients. Hellenic Society of Gastroenterology 2019 2018-11-29 /pmc/articles/PMC6302199/ /pubmed/30598587 http://dx.doi.org/10.20524/aog.2018.0330 Text en Copyright: © Hellenic Society of Gastroenterology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Special Article Dalekos, George N. Koskinas, John Papatheodoridis, George V. Hellenic Association for the Study of the Liver Clinical Practice Guidelines: Autoimmune hepatitis |
title | Hellenic Association for the Study of the Liver Clinical Practice Guidelines: Autoimmune hepatitis |
title_full | Hellenic Association for the Study of the Liver Clinical Practice Guidelines: Autoimmune hepatitis |
title_fullStr | Hellenic Association for the Study of the Liver Clinical Practice Guidelines: Autoimmune hepatitis |
title_full_unstemmed | Hellenic Association for the Study of the Liver Clinical Practice Guidelines: Autoimmune hepatitis |
title_short | Hellenic Association for the Study of the Liver Clinical Practice Guidelines: Autoimmune hepatitis |
title_sort | hellenic association for the study of the liver clinical practice guidelines: autoimmune hepatitis |
topic | Special Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302199/ https://www.ncbi.nlm.nih.gov/pubmed/30598587 http://dx.doi.org/10.20524/aog.2018.0330 |
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